ReviewProximal femoral fractures and vascular injuries in adults: Incidence, aetiology and outcomes
Introduction
Proximal femoral fractures (PFF) and their management continue to be a subject of great attention to the clinicians. The underlying poor bone stock, the increased incidence of fracture comminution, and the high incidence of comorbidities in the elderly patient population may lead to a higher risk of complications and mortality [1], [2], [3], [4], [5], [6], [7].
Vascular injuries (VI) during the course of internal fixation (IF) in PFF could be potentially limb and life-threatening [8]. There are infrequent reports about their presentation in journals [9] and some references in expert textbooks of orthopaedic trauma [10], [11], [12], [13]. As the incidence of hip fractures is expected to increase dramatically during the next decades, similarly, the incidence of VIPFF-IF is expected to rise.
The purpose of this systematic review of the literature therefore is to investigate the distinct frequency of each of the injured vessels, the mechanisms and types of injury, the diagnostic and therapeutic modalities, the outcomes, and to recommend several tips for its prevention.
Section snippets
Materials and methods
This review was conducted in accordance to the PRISMA guidelines [14]. Data were documented according to a standardised protocol, where objectives and inclusion criteria were specified in detail.
Searches were conducted using the following databases: Cochrane Library, Pubmed, Embase, Springer, OvidSP, ScienceDirect, Dialnet, J-Stage, Scielo, and KoreaMed, and also the Google Scholar searcher. The following keywords were used: “artery”, “vein”, “injury”, “pseudoaneurysm”, “thrombosis”,
Results
After omitting studies that did not fulfil the inclusion criteria or were repeated in the databases search, 161 studies were primarily selected for review. Of these, one case included in one study [15] is questionable and for this reason was excluded, leaving 160 articles reporting on 182 cases [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49],
Discussion
The distinct frequency of injury to each vessel in PFFIF is related to the anatomy of these vessels in relation to the femur (Fig. 1), the procedures of reduction and internal fixation and the proximal displacement of the lesser trochanter fragment.
The intrapelvic projection of the tip of the instruments and implants placed in the femoral head, especially if the hip is adducted and rotated internally, is in the path of the external iliac (Ei) vessels which run near to the bony surface of the
Conflict of interest
The authors report no conflict of interest with regard to the content of this manuscript.
Acknowledgement
The authors would like to thank AO members from Japan, Russia, and Taiwan, for their help in providing us with full text articles from their countries and their translation.
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